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Coronary Microvascular Dysfunction: A Guide for Clinicians - 28/08/24

Doi : 10.1016/j.amjmed.2024.04.035 
Hannah Smati, MD a, Frank W. Sellke, MD b, Jamieson M. Bourque, MD, MS c, Yusuf Kamran Qadeer, MD d, Giampaolo Niccoli, MD, PhD e, f, Rocco A. Montone, MD g, Chayakrit Krittanawong, MD h,
a Department of Medicine, Baylor College of Medicine, Houston, Texas 
b Division of Cardiothoracic Surgery, Cardiovascular Research Center, Brown University Warren Alpert School of Medicine, Providence, RI 
c Division of Cardiovascular Medicine and Radiology, University of Virginia Health System, Charlottesville 
d Division of Cardiology, Department of Medicine, Henry Ford Hospital, Detroit, Mich 
e Department of Medicine and Surgery, University of Parma, Italy 
f Division of Cardiology, Parma University Hospital, Italy 
g Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy 
h Cardiology Division, NYU Langone Health and NYU School of Medicine, New York, NY 

Requests for reprints should be addressed to Chayakrit Krittanawong, MD, Cardiology Division, Section of Cardiology, NYU School of Medicine, 550 First Avenue, New York, NY 10016.Cardiology DivisionSection of CardiologyNYU School of Medicine550 First AvenueNew YorkNY10016

Abstract

Dysfunction of the coronary microvasculature has become increasingly recognized as an important mechanism of myocardial ischemia in patients without obstructive coronary artery disease. The causes and management of coronary microvascular dysfunction remain poorly understood and are still largely based on extrapolation of epicardial coronary artery disease data. Quantification of myocardial blood flow and flow reserve have improved diagnosis, though important questions remain. In this review, we explain current understanding of the spectrum of pathophysiology of coronary microvascular dysfunction, summarize current diagnostic techniques to assess for coronary microvascular dysfunction, and appraise the limited data on management options specifically for patients with coronary microvascular dysfunction.

El texto completo de este artículo está disponible en PDF.

Keywords : CMD, Coronary flow reserve, Coronary microvascular dysfunction, Index of Microcirculatory Resistance


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 Funding: National Institutes of Health. R01HL46716 and R01HL128831 to FWS.
 Conflicts of Interest: CK discloses the following: Member of the American College of Cardiology Solution Set Oversight Committee, The American College of Cardiology/American Heart Association (ACC/AHA) Joint Committee on Clinical Data Standards, the American Heart Association Committee of the Council on Genomic and Precision Medicine, and the ACC/AHA Task Force on Performance Measures, The Lancet Digital Health (Advisory Board), European Heart Journal Digital Health (Editorial board), Journal of the American Heart Association (Editorial board), JACC: Asia (Section Editor), The Journal of Scientific Innovation in Medicine (Associate Editor), and Frontiers in Cardiovascular Medicine (Associate Editor). FWS is a co-founder of XM Therapeutics, but there is not relationship or conflict of interest with this manuscript.
 Authorship: All authors had access to the data and a role in writing the manuscript. HS: Writing – review & editing, Writing – original draft; FWS: Writing – review & editing, Supervision; JMB: Writing – review & editing, Supervision; YKQ: Writing – review & editing; GN: Writing – review & editing, Supervision; RAM: Writing – review & editing, Supervision; CK: Writing – review & editing, Visualization, Validation, Supervision, Conceptualization.


© 2024  Elsevier Inc. Reservados todos los derechos.
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Vol 137 - N° 9

P. 810-817 - septembre 2024 Regresar al número
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